Posted on 29 July 2022

A controversial review has made headlines this week after it claimed the smoking age in the UK should be raised year on year until the point no one is allowed to purchase tobacco, smoking material or other nicotine containing products. The review was written by Javed Khan, an ex charity mogul who delivered the report on behalf of health ministers within the government and cabinet, sources say. Across the UK, there are still 7 million active smokers, with 85% of them living in England alone. In the recent years, much has been made of the taboo issue of smoking, and a change of public opinion has grown to where smoking has become a communal taboo topic, unlike other vices such as gambling, alcohol and drugs. The report demands that less than 5% of the population should be active smokers by 2030, with red tape and possible bans incoming.

1 in 9 18-24 year olds currently smoke in the UK, and smoking itself has become somewhat of a ‘bad thing’ that is often engaged in by younger people for the image of rebellion and protest because of the glamorisation of smoking in younger circles, influenced by the media and public perception. Indeed, there has been a reason move towards vaping nicotine which is seen generally as a ‘healthier’ way of engaging in smoking behaviour, yet it is just a different form of nicotine – not an active disengagement of substance use. Year on year, there are around 75,000 excess smoking deaths which are entirely preventable, with 1 in 4 cancers currently linked to current or former smoking behaviour. Vapes do not contain tar or other carcinogens, yet much has been made of the other constituents in e-cigarettes which are potentially toxic and just another mechanism by which cancers can occur. It’s currently thought over 30 million people vape in the UK, a big change – and the vaping industry has become a large player in legal substance use. Almost 2% of 16-19 year olds began vaping in the last 3 years without having ever smoked – raising concerns that regardless of the method of consumption, there is still the interaction with mild substance use, especially when vaping is currently extremely popular.

Other recommendations in the report from Mr Khan, sourced by BBC, include;

  • Setting aside an extra £125m for smoke free policies, with an extra £70 million per year ring-fenced for stop smoking services

  • Promotion of vapes as an effective "swap to stop" tool to help people quit smoking

  • Introducing a licensing system for shops to sell tobacco and banning supermarkets altogether

  • Increasing duties on products and banning duty-free tobacco

However, smoking has been particularly maligned in public perception, with other substances, namely alcohol, causing much more harm to individuals, society and family members affected by alcoholism. A YouGov poll in 2021 found that 3 in 5 Britons support an outright ban on smoking, perhaps a surprising number given how perception has changed dramatically from the 1990s, indoor smoking ban and prohibition. Indeed, half of Britons from the same poll want to see vaping banned outright, showing there is a mixed opinion in the general public. Drinking alcohol beyond the recommended amount is highly correlated with cirrhosis, emergency department visits, cancers, gastrointestinal problems, weight gain and cardiovascular disease, with 25,000 excess deaths from drinking expected just from the 2020 lockdown year. Alcohol is currently sold without any majorly visible warning labels, whereas cigarette packets are laden with pictures of death, disease, miscarriage and cancers. If alcohol poses a similar cancer risk, why are warning labels not included on alcohol bottles, cans and boxes? Included is a chart which shows the differing impacts of drug behaviour when rated as personal, societal and dependence.

Digging deeper into the data, Prof Jane Green from the Epidemiology and Cancer Epidemiology Unit at Oxford commented on a 2019 report into the equivalence of cigarette smoking when proportional to alcohol consumption;

“It is important to view these results in context.For both men and women in the UK, the lifetime risk of cancer is around 50%.The authors estimate that lifetime risk is around 1% higher for men and women who drink a bottle of wine a week, or who smoke 5-10 cigarettes a week, than for those who neither smoke nor drink.The average UK drinker reports drinking the equivalent of about a bottle and a half of wine a week, and the average smoker smokes about 10 cigarettes a day, or 70 a week.This work confirms that for most smokers, their smoking carries much greater risks for cancer than does alcohol for most drinkers.Moderate levels of drinking are in absolute terms particularly important for cancer risk in women, because they are associated with increased risk of breast cancer, which is very common (lifetime risk of 14%).”

It’s to be seen whether we see tobacco bans within our lifetime, but a rational approach to substance use must be reviewed in the UK, as it is tantamount to neglect to not consider alcohol and prescription drugs alongside tobacco. Indeed, alcohol causes more social harm and accidents – such as drink driving, falls and emergency visits than tobacco specifically. But whilst alcohol may cause A&E visits, smoking healthcare presentation occurs much later in life when the effects are cumulative and cause harder to treat cancers, and thus eventual harm. A rational debate into the pros and cons of prohibition of tobacco must be levied in the UK, and it is not neglectful to discuss the autonomy of one’s own person to decide how they engage with substance use. But whilst we discuss the prohibition of tobacco, it seems dishonest to not count up the cumulative toll of other legal substances like alcohol in the same discussion.

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